Working the Voice Back from the Brink, Part 1 // Judy Rodman

“Please help me; how can I get my voice back?" As a vocal coach, this is one of the most common questions I get, and a primary reason singers and speakers seek vocal training. If you teach voice, I’m sure you are no stranger to this cry for help. Let me share some things I’ve learned:

First, do no harm!

If you have any suspicion there could be vocal damage, it’s vital for ethical and legal reasons to recommend a visit with a doctor, optimally with a fellowship-trained laryngologist who specializes in voice. Here in Nashville, I send people to Vanderbilt Voice Clinic. Before working with a student who has seen a doctor, make sure understand their medical diagnosis and/or procedure, as well as any recommendations such as a prescribed period of voice rest.

Before beginning any vocal recovery work, have a holistic discussion about vocal health with the student. The wounded voice needs extra hydration so ask if they are drinking enough water. A general rule is to drink half the body weight in ounces daily. I suggest a warm air humidifier in smaller rooms, especially while sleeping.  Breathe in steam from a shower. The healing voice needs everything else the body needs… sleep, quality non-phlegm inducing food, sunshine, stress-relief. 

Case study 1:

I had a singer who I’d never worked with before email me asking for help. She told me a doctor diagnosed her as having vocal nodules and prescribed a couple of weeks of total voice rest. However, she had an important TV show that weekend that she just COULDN’T miss, so could she come in and get some advice and warmup exercises to get her through that performance?

Two potential images popped into my mind: A vocal hemorrhage and a lawsuit. Hmm.

I emailed my reply ‘sorry, no’ while silently mouthing ‘hell, no!’ I told her I wouldn’t meet with her until she got clearance from her doctor to gently begin vocal exercise. I added my strong suggestion that she cancel her gig. She eventually did rest her voice, got that doc’s approval, and came in for a lesson after which her voice felt and sounded much better. With wise voice work, her nodules should continue healing and her voice should come back with no further need for medical intervention. And the training will protect her from damaging her voice again now and in future! 

Case study 2:

An older gospel singer came in with vocal trouble. I took him through some vocal exercises that temporarily eased the pressure on his vocal folds, corrected his posture and gave him some relief. But I suggested he go 'get his cords scoped.'  My suspicions were confirmed… he was diagnosed with an inoperable polyp and told he should get another line of work. Without asking me, and after some prayer, he decided not to stop his concerts. But he faithfully stuck to the new ‘pulling’ method I teach which corrected his pushed breath habit and opened his tight throat. His wife, a long-time student of mine, would sit in the front row at his shows. With her body language she’d remind him to pull back when he began to push. Two years later after continuing to sing, he went back for a checkup to Vanderbilt Voice Clinic. His new laryngoscopy showed his polyp was completely gone! Here are laryngoscopy photos of his ‘before’ and ‘after’, which he gave me permission to share:

Second, find out why the voice was lost.

Ask detailed questions. Getting to the cause of voice loss is essential to getting on the safest, fastest path to vocal recovery. Causes I’ve found fall within two overall categories: 1. organic tissue damage from disease, trauma or disorder, and 2. abusive vocal technique.

ORGANIC TISSUE DAMAGE can include:

• Viral laryngitis, which can have lingering effects even after the infection has subsided. Fear creeps in and counterproductive over-trying is common. Careful retraining is needed, with emphasis on relaxing tension and working the head register.
• Chronic or hard coughing from respiratory illness, smoking or inhaling other throat irritating particles. One must discover and eliminate the source!
• Acid reflux, more formally called Gastroesophogeal Reflux Disease (GERD). It can manifest symptoms such as unpleasant heartburn, or can have no apparent symptoms (known as silent reflux). Even silent reflux can cause significant vocal problems. The damage to the tissues of the esophagus and larynx from acid reflux can not only lead to frustrating laryngitis but also to a pre-cancerous condition called Barrett’s Esophagus, which can progress to cancer. CAUTION: Acid reflux can be a serious issue. If you suspect it, be sure and have the student consult a medical specialist. In some cases, strong medications are prescribed. However, I find that very often all that is needed is food enzymes with significant meals. You could try a formulation called HCL Pepsin (under many brands) or a product that is a combination of enzymes that helps digest protein, fat and carbohydrates. I’ve had great success with Digestzymes by Designs for Health. You should also watch your diet, limit hard to digest foods and possibly raise the head of your bed. 
• Strain in neck or shoulder muscles, causing concurrent tension in and around the vocal apparatus. Even the so called ‘crick in the neck’ can cause voice-stealing tension. I worked with an artist who strained his neck exercising with free weights incorrectly. The resulting neck tension caused him to overwork his vocal apparatus. He pushed his strained voice so hard on stage to make it work, he lost the ability to sing with the vocal range his songs required. He stopped singing for 4 years. Thankfully, vocal re-training enabled him to get back into the studio and on the road. 
• Psychological and neural disfunctions including spasmodic dysphonia, intense stress or extreme insecurity. Spasmodic dysphonia can only be temporarily helped by stabilizing the larynx and ribcage with excellent technique, but this disorder is frustratingly neurological. The usual treatment protocol involves injections of botox into the vocal cords.
• Muscle tension dysphonia (MTD) is the condition when muscles around the larynx tense and inhibit the free function of the vocal apparatus. MTD crosses both our categories here… scrambled nerve pathways are involved but abusive vocal technique can lead to those confused neural paths. The MTD cases I work (both singers and speakers) with require patience and time in the re-setting of automatic function, but consistently applying vocal techniques that open throats and suspend larynx and diaphragm into stability are taking the glitches out and helping them trust their healing voices again.
• Crying, which can swell tissue and induce at least short-term vocal loss. Time is needed for tissues to shrink.
• Physical trauma to the larynx such as an elbow during a basketball game (yes I had that student), or being choked (had that student, too.) Again, time is needed for tissue to heal. Then careful vocal exercises that create breath efficiency and open throat expansion should begin.
• Scar tissue on the vocal folds, or a similar issue called sulcus vocalis. There can be different degrees of scarring and sulcus. I’m not sure all cases can be helped but I can report success in getting students diagnosed with these issues singing again. It is vital to maximize breath efficiency for this vocal damage to have the opportunity to soften and heal over time. There are also surgical solutions for extreme cases.
• Vocal cord paralysis. This issue can occur in one or both cords and to different degrees. There are physical and psychological causal factors. I had a new student come in whose vocal cord was diagnosed as partially paralyzed. After three weeks of coaching her through careful strain-reducing vocal exercises and easy songs, she went in for another check-up and her vocal paralysis had disappeared. I never guarantee results until I get them but in my coaching experience, good vocal exercises performed correctly over time can do miracles!

MY STORY:

I sustained what my doctors suggested was permanent scar tissue on my vocal cords from an endotracheal tube. I required the intubation several times during a three-month hospital stay for complications from Crohns Disease, childbirth and life-but-not-voice-saving surgery. And yes, I fully recovered my health, my voice and my career!

ABUSIVE VOCAL TECHNIQUES can include:

• Pushing excessive breath pressure through the vocal folds! Yelling and whispering are both examples of pushing uncontrolled breath. This is the #1 cause of singing and speaking voice loss.
• More pushed examples: Laughing hard, loud, and/or forward. Cheering, talking to be heard over loud music. 
• Speaking or singing without enough breath support, often resulting in frequent hard glottal starts, uncontrolled vibrato and/or habitual vocal fry.
• Chronic bad posture resulting in a collapsed lower ribcage, a slack diaphragm and a tight throat.
• Singing or speaking through a tight throat. Symptoms include frozen facial language such as tight jaw, still eyes with frozen eyebrows, mumbled words. 
• Raising and/or jutting the chin forward for high notes. This raises the larynx uncomfortably and is a terrible stressor on the vocal apparatus. 
• Singing songs out of the current vocal range – which means, the singer can’t reach certain notes without straining no matter how correct their technique. A good teacher will say… this is not for you right now. Maybe in a year or so, but not now.
• Singing too long without warming up or developing the required stamina.

Third, get to work!

Now that any doctor-prescribed voice rest has been honored, and the cause(s) of voice loss discovered, we can develop a protocol for working the voice back, which we'll explore net week.