Frances Ascott Clinical Lead Speech and Language Therapist Vocal Health 24/04/2017 Frances Ascott Clinical Lead Speech and Language Therapist

Contact information Frances Ascott ENT Dept Manchester Royal Infirmary 0161 276 4215 (voicemail) frances.ascott@cmft.nhs.uk

Course Outline Basic structure of vocal mechanism Day to day protection-recognising a problem Common problems and advice Seeking further help Dealing with stresses Anat- today but don’t give up Function-how we make sound and different sounds Falsetto, twang, belt some learning through experience Observation of function- opportunity to be scoped see anatomy see it function. All or as many want in 4 groups 30mins each

Learning Objectives To understand the factors which affect voice To know how to keep the voice healthy To know what to do when something goes wrong.

Opportunity for Questions As we go along At the end of sessions Make an appointment/arrangement At end of course

Oral and Pharyngeal cavity 24/04/2017 Oral and Pharyngeal cavity The oral cavity (volume 100cc) is a primary location for the articulatory shaping of the voice signal. Not fixed shape or size. The articulators -- the lips, tongue, teeth, and jaws -- are responsible for shaping the voiced signal into the different types of phonemes such as consonants and vowels. The oral cavity is bounded by the lips anteriorly, the cheeks laterally, the hard and soft palates superiorly, the tongue inferiorly, and the faucial pillars and pharyngeal wall posteriorly Label tonsils, epiglottis, adenoids, larynx, vocal cords, etc Pharyngeal Cavity volume 80cc The pharyngeal cavity runs from the base of the cranium to the top of the oesophagus at an approximate level of the sixth cervical vertebrae. The pharynx is formed primarily by three muscles arranged in a circular pattern that attach to structures anteriorly. The pharyngeal muscles, also known as the constrictors, include the superior, middle and inferior pharyngeal constrictor muscles. The pharyngeal space allows communication between the nasal, oral, and laryngeal cavities. It forms a connecting corridor located posteriorly to the nose, mouth, and larynx. The pharynx is subdivided into three functional levels that correspond to the structures found anteriorly. The nasopharynx is located posterior to the nasal cavity, the oropharynx is located posterior to the oral cavity, and the laryngopharynx /Hypo pharynx is located posterior to the larynx. Supraglottic Vocal Tract may also be used as a term to include

Oral cavity Contains the articulators Lined with moist mucosa Salivary glands secrete to maintain moisture Air enters through here for singing

24/04/2017 Nasal cavity

Nasal Cavity Nasal sounds m, n ng 24/04/2017 Nasal Cavity Nasal sounds m, n ng Nasality controlled by the velopharyngeal port Too much air escape = hypernasal Inadequate nasality “bunged up” = hyponasal Cranial bones superiorly, nasal turbinates laterally, the hard and soft palates inferiorly and the pharyngeal wall posteriorly. Lined with wet mucosal membrane Air warmed and moistened as passes over large surface area. Smell receptors linked to brain. Sinuses and cavities in skull are linked to nose

The Larynx Part of the vocal tract Top of the trachea Primarily designed for airway protection so is hard wired t.o close up. 3 sphincters Raising and lowering

Laryngeal Framework Cartilages Bone 1 x epiglottis 1 x thyroid 1 x cricoid 2 x arytenoid 2 x corniculate 2 x cuneiform Bone hyoid The larynx is a musculocartilaginous structure located in the anterior neck which is suspended by muscle and ligaments to the hyoid bone superiorly and attached to the trachea inferiorly. There are 9 laryngeal cartilages Corniculate - set on apex of arytenoid cartilages Cuneiform - embedded in aryepiglottic folds

Laryngeal framework

Soft Tissue Structures 24/04/2017 Epiglottis Ventricular bands Vocal cords White, shine, Play video clip, show open, closed, breathing, phonation Trachea

Extrinsic muscles Titze 1994

Laryngeal Elevators Elevators Digastric Stylohyoid Mylohyoid Geniohyoid Hyoglossus Genioglossus muscles Listed so that you have heard of them How named attached to hyoid / tongue Point to note that there are more of them than the depressors Palpate mylohyoid +/- swallow

Laryngeal depressors Sternohyoid Omohyoid The laryngeal depressors are the sternohyoid and omohyoid muscles. They pull down the larynx rather than push it down (infra hyoid muscles) Much lowering of the larynx is by a relaxation of the suprahoid muscles

Looking after your voice

General Voice Care Principles Levels of care different for each person Male voice generally stronger Take responsibility for your voice Take extra care when more at risk Risk factors change with age/fitness Age 45 and develop problems

Warning signs 1 These are symptoms that you may experience, which will alert you to the need to take extra care, or that you are not using your voice correctly. Each symptom listed may occur for a number of reasons, however we have made some specific suggestions of responses to try first.

Warning signs 2 Frequent throat clearing - Don’t do it sip water instead Pain/soreness in the throat - yawn to release tension, don’t push Hoarseness/Croakiness/Creak - don’t run out of breath Tickly cough - don’t be too loud & push 

Warning signs 3 Voice loss - watch breath support and neck tension Voice tired at the end of the day- watch breath support etc Lump in throat - reflux, yawn to relieve tension Loss of power/ability to shout - practise humming and breath support apply to being loud situations Dryness – sip water frequently

Times to take care When you return to work/singing after a holiday or illness When you are experiencing some of the warning signs Sore throats with/without an infection When you are tired When you are stressed

Avoidance of strain Avoid unnecessary talking over noise and incorrect shouting. If you need to shout try to do so with a smile. It should feel comfortable. Do not compete with background noise particularly when tired Avoid repeated throat clearing. Try swallowing or sipping water. Be aware of catarrh. Inhaling steam may help, catarrh may be linked to dairy products Sing instead of shout Voice projection even when close Frequent throat clearing causes catarrh How to recognise strain Tickle, dryness,voice crack up, fatigue,change quality,pressed sound

Areas affecting safe voice production Tension and relaxation Posture Breathing Resonance Volume Muscular energy Intonation, pitch, pace and pause Use salutations

Environment Reduce the effects of hot dry environment by opening windows, layer dressing so keeping cool and comfortable. Avoid environmental fumes such as smoke and chemical smells where possible. A lot of individual differences here NB take note when at risk Smoking SHOW smoking clip

Posture and Breathing Maintain good posture with no unwanted tension. Check: easy head / neck / back alignment Use good breathing from the lower part of the lungs. Chan R. W. Does the voice improve with vocal hygiene education? A study of some instrumental voice measures in a group of kindergarten teachers. J Voice 8 (3):279-291, 1994 Those with problems improved Alexander technique